Intracranial Atherosclerosis

Your brain contains a network of arteries – blood vessels that provide it with oxygen-rich blood. Intracranial atherosclerosis disease (ICAD) – sometimes called “hardening of the arteries” – occurs when these arteries become clogged with a sticky substance called plaque, made up of deposits of fat and cholesterol. This limits blood flow to your brain and increases your risk of a stroke.

Overview

Symptoms

A neurovascular disorder, ICAD generally has no symptoms, and is often discovered only after you’ve had a stroke.

You may be at a higher risk if you’re African American, Hispanic or Asian; if you’re a man; or if you’re over the age of 50. Certain health conditions can also increase your chances of ICAD. These include diabetes, heart disease or arterial disease; obesity; high blood pressure or high cholesterol; and having had a previous stroke or a family history of stroke.

Diagnosis

To diagnose the condition, your doctor may order tests to examine the arteries in your brain. These may include:

Computed tomographic angiogram (CTA): A special dye is injected into your bloodstream, which allows your doctor to view blood flow on a CT scan.

Digital subtraction angiography (DSA): An X-ray is performed while dye is injected into your bloodstream. A computer then digitally alters the image to allow a clear picture of the blocked arteries.

Transcranial Doppler ultrasound (TCD): A probe that generates high-frequency sound waves is placed over your skull. By measuring the change in these waves, your doctor can see the direction and speed of blood flow inside your head.

Transcranial color-coded sonography (TCCS): This ultrasound test is similar to TCD, but your blood flow is color-coded.

MRI

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Treatment Options

If you have early-stage ICAD, your doctor may recommend medication and lifestyle changes to help decrease your risk of a stroke. However, if your doctor finds a significant blockage in your artery, you may need one of the following treatments for intracranial atherosclerosis:

Intracranial angioplasty: Your surgeon will insert a balloon into the artery and inflate it to widen the space inside. Then, a stent (an expandable tube) is placed in the space to keep the artery propped open.

Cerebral bypass surgery (ECA/MCA/STA bypass surgery): First, your doctor will remove a blood vessel from another part of your body. Then he or she will drill a small hole into your skull and surgically connect the new vessel in your brain so blood can flow around the clogged artery, bypassing it entirely.

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